Healthcare Analyst (Provider Reporting)

  • Full-Time Job
  • New York, NY
  • $59,800 - $97,155 USD / Year

Website Healthfirst

The Healthcare Analyst (HCA) provides support through the research and investigation of business issues related to cost, utilization, and revenue data for multiple Healthfirst products. The HCA will identify/monitor cost and utilization trends and the root causes in health plan trend performance and provide recommendations for solutions.
The HCA will interact with divisional subject matter experts, Network, and IT and other areas of the organization to provide support in various tasks related to achieving business objectives. The HCA will contribute to a broad set of projects across the department. This position requires an individual with emerging skills who enjoys working in a fast paced and challenging environment. The HCA works in partnership with other areas of Finance to provide key insights and analysis to our internal stakeholders across departments like operations and medical management as well as our external hospital and provider networks.

Job Description

  • Analyze the financial performance of all Healthfirst products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to management.
  • Candidate will monitor costs and revenue trends and assist in understanding trends.
  • Responsible for creating, modifying, and updating risk arrangements for the Provider Organizations.
  • Responsible for contract analysis and fee schedule modeling.
  • Understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory
  • Payment Classifications (APC’s), and other payment mechanisms.
  • Knowledge of Medicaid, Medicare programs and Healthcare industry

Minimum Requirements:

  • Bachelor’s degree or higher from an accredited institution with a concentration in Finance, Accounting, Business, or Healthcare Administration
  • Advance skills in SQL (Joins, CTE etc.) and advanced Excel (lookups, formulas, index match, pivots, etc.)
  • Self-motivated, creative problem solver who can work independently and collaborate through strong communication and interpersonal skills.
  • Ability to handle multiple projects in a fast-paced environment.
  • Strong interest in pursuing a career within the Healthcare industry.

Hiring Range:

Greater New York City Area (NY, NJ, CT residents): $67,200 – $97,155
All Other Locations (within approved locations): $59,800 – $88,910

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